Driving of the personal vehicle is the primary and preferred mode of travel for older adults in the US. More than fulfilling the critically important """"""""getting around"""""""" or mobility function, driving in older adults profoundly impacts health status and thus has direct public health relevance. Being a driver has been linked to increased quality of life, reduced likelihood of depression and social isolation, and increased accessibility to healthcare. Therefore policies defining the vision standards for licensure as applied to the elderly population must be rational, i.e., evidence-based. This research is designed to take critical steps toward establishing this evidence-basis by making use of unique opportunities and resources available in Alabama. Alabama is a state with no visual acuity re-screening after initial licensure. Such a situation represents an opportunity to conduct a study would overcome methodological problems of earlier studies purporting to examine the association between visual acuity and crash involvement and the safety benefit of visual acuity re-screening of senior drivers. The distribution of visual acuity values in a study carried out on drivers licensed in Alabama will not be limited to those with good visual acuity, since drivers with visual acuity impairment are not detected and removed from the road by a re-screening law as they would be in most other states. Toward this end, a prospective study on older drivers ages = 70 years will be carried out, where certain visual and cognitive functional screening tests will be administered at baseline, followed by tracking of the samples'crash data for the subsequent three years. This research program is translational in that it involves the translation of basic research findings on what factors elevate the risk of older driver crash involvement to the practical issue of how these known risk factors can guide screening for re-licensure in this population. The practical question to be addressed is what screening tests and cutpoints should motor vehicle licensing offices be using when older drivers present for license renewal in order to optimize older driver safety in the subsequent years? Using the data from this prospective study, we will be able to determine the number of at-fault crashes for the cohort that would have been prevented had various screening criteria for license removal been implemented at baseline. This will allow us to characterize the public safety benefit of the various, alternative screening criteria for licensure of older drivers, information that will be useful to state agencies in designing driver re-screening policies to optimize public safety.
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